Are there any factors influencing the course of multistage treatment in Hirschsprung’s disease?

Abstract

IntroductionSurgical treatment of Hirschsprung's disease may be performed in a single step, or in stages with a temporary stoma. The therapy depends on the clinical condition of the patient and the severity of symptoms. Planned multistage treatment is carried out in two or three steps.AimTo analyse our 15 years of experience with multistage surgery for the treatment of Hirschsprung's disease, to identify multistage-related factors influencing the course of surgery and hospitalisation, and to evaluate the probability of complications during multistage treatment.Material and methodsThe study material was collected on the basis of documentation of patients treated during the years 2000 to 2014. The parameters concerning surgery and hospitalisation were statistically analysed.ResultsTwenty nine patients were treated with multistage surgery using the following methods: Duhamel-Martin and Transanal Endorectal Pull-Through (TEPT). There were significant correlations (p < 0.05) between length of resected intestine and operative time. Classification and Regression Tree (CRT) was used to classify the operated children depending on the presentence of complications after surgery.ConclusionsThe incidence of complications during multistage treatment for both methods was comparable. It is difficult to objectively compare the Duhamel-Martin and TEPT techniques because of the different indicators for their use in multistage surgery. Intestinal adhesions were the most common complication after definitive surgery. Younger age of the operated patients was associated with greater risk of adhesion formation.

Transanal endorectal pull-through procedure versus transabdominal surgery for Hirschsprung disease

“…The studies of Sosnowska et al, [10] Onishi et al, [9] Tannuri et al, [11] and Ishikawa et al [12] reported the full data for the operative time (Table 3). There was no significant difference in the operative time between the TERPT group and the TAB group (MD = −30.59 min, 95% CI −98.01–36.83, P = .37) (Fig.…”

“…Eight studies [6,9–15] reported postoperative enterocolitis, but only 1 [10] reported the total incidence of postoperative enteritis in the 2 groups, so this study was not included in the postoperative enterocolitis analysis (Table 3). Two studies [6,11] defined enterocolitis (Table 4).…”

“…Four studies [9,12–14] compared the incidence of postoperative incontinence/soiling, postoperative constipation, and postoperative enterocolitis after the TERPT and Soave surgeries. Four studies [7,8,10,11] compared the incidence of urinary incontinence/contamination after the TERPT and Duhamel surgeries.…”

Comparison of the Duhamel Procedure and Transanal Endorectal Pull-through Procedure in the Treatment of Children with Hirschsprung’s Disease: A Systematic Review

“…Currently, the use of an Endo-Cutting Stapler for side-to-side anastomosis has made this procedure more convenient [14]. However, the residual aganglionic rectum and the Duhamel pouch in this procedure were reported to be related to postoperative complications such as constipation [15][16][17][18][19][20][21][22][23][24][25].…”

“…Subsequently, several studies have reported favorable results of TERPT compared with other types of surgical procedures [12,29]. However, anal sphincter stretching and transanal mobilization of the rectum during this procedure were reported to increase the risk of complications such as soiling, constipation, and fecal incontinence [15][16][17][18][19][20][21][22][23][24][25].…”